An Open Letter to Medicine, Nursing, and Public Health upon Reaching The Limits to Growth

Conventional wisdom maintains that we are slowly recovering from a recalcitrant recession. As we are now entering at least the third year of real economic contraction, continue to reel from the depredations and corruption in a financial sector the federal government treats as sacrosanct, are in the sixth year of a plateau in worldwide oil extraction, and climate change is essentially unmitigated, it should be obvious that American society is arrantly unsustainable – ecologically, fiscally, economically, politically -and ethically.

Few in medicine, nursing and public health share our view; the overwhelming majority of practitioners and their leaders wait –silently, nervously. Many are sincere in this hope for “recovery” because they are –excuse our bluntness- ignorant of how the earth’s ecosystems, resources and the laws of thermodynamics set the parameters of human economic activity.

Succinctly, the world is reaching the physical limits to economic growth. This metaphor, of a finite planet with limited resources and delicately balanced ecosystems, can lead us toward an intellectual paradigm, cultural values, mythology and national identity that support a sustainable world. It follows that it is the narrative from which to generate a new paradigm for the health sciences in the 21st century. It informs us that we are not going back to business as usual and, further, challenges us to envision a future where medicine, nursing, public health and allied fields redefine their place in both the natural world and the political/economy, by which we mean the relationships between economic activity and law, finance, culture, science, and government.

We suggest that mainstream health policy analysis is in an intellectual cul-de-sac due to its paradigmatic premise that the economy will continue to expand and thereby allow the government to provide more and more funding for health. For example, a 2009 issue brief[i] by the American Public Health Association, APHA, examines the harm caused by the decline in funding for “The Safety Net” of health services caused by the economic downturn of 2007-2008. The main policy recommendation is a call for more government funding. This only makes sense if there will be a return to growth; but it is barren of guidance if we are entering a sustainability crisis. The limits to growth inspired question to the health sciences, therefore, is inescapable and simple: How do you protect and promote health without an ever-growing economic pie?

It is tragic yet no great surprise that the only branch of government (openly) planning for peak oil (reaching the maximum rate, worldwide, of petroleum extraction) is the military; not health and human services, transportation, agriculture, energy, commence, treasury, nor homeland security. (See this bibliography of approximately 40 studies and reports from military sources about energy scarcity, many specifically addressing peak oil.[ii])

In this vein it is noteworthy that in 2005 a branch of the Department of Energy released a report on peak oil, AKA “The Hirsch Report.” In a properly functioning democracy this report would have at the least prompted vigorous public discussion and debate. The leaders of public health, nursing, and medicine would have paid especial attention to this report given the dire threats peak oil poses to the social determinants of health and to the operation and complexity of health delivery systems. Few outside of the peak oil community know of this report because the reaction of the DOE in Washington was, paraphrasing Hirsch: No more studies of peak oil.

For context, as the Hirsch Report languished –the DOE had to be pressured by citizens to make it available online- the then vice-president was promoting a “1% doctrine” of terrorism policy, ostensibly to protect the public from any terrorist attack, no matter how slight the chance of it occurring. Related to the War on Terror, public health preparedness for a mass casualty terror attack or natural disaster was booming. (Preparedness has morphed into this must-see-to-be-believed APHA rendering of Aesop’s fable of the “The Ant and the Grasshopper” – [http://www.youtube.com/watch?v=s03oOcow-_s]).

It is becoming evident to increasing numbers Americans that public policy is broken; polls and on-the-street interviews indicate many citizens will not vote this fall because they view Republicans as hostile to the common person and feel Obama has dashed their hopes for change. Writes Yves Smith, editor of the highly regarded website, Naked Capitalism, “The Obama Administration is entirely predictable. It ever and always sides with large corporate interests, while trying to create the impression that it is actually concerned for the welfare of the average citizen.”[iii]

Here is the theory underlying her observation: “regulatory capture occurs because groups or individuals with a high-stakes interest in the outcome of policy or regulatory decisions can be expected to focus their resources and energies in attempting to gain the policy outcomes they prefer…” For example, the federal government’s TARP was only the tip of an approximately $14 trillion[iv] bailout and backstopping guarantee iceberg; and the federal government’s handling of the BP Deepwater Horizon oil catastrophe is still being revealed for all its dissembling and disregard for the public interest and natural ecology. And we believe the emerging home foreclosure imbroglio, which is rife with fraud and corruption, not “paperwork problems” will further illustrate regulatory capture.

A central problem of the health sciences is that they too are captured, by the federal government’s version of reality. Some in public health will recall that two years ago The APHA sent multiple emails to its members urging them to contact their congressional representatives in support of the TARP, when 70% to 80% of the public opposed the program. One of us contacted APHA headquarters in Washington to point out that supporting this program was both unpopular and a blank check, panic mode policy. The response from the APHA was Washington insider boilerplate that TARP would fix the economy in six months and that, moreover, there were funds in it for public health (less than 1%).

Although the current administration has consistently maintained, “TARP was a success,” the latest report from the Special Inspector General for TARP details why this is a wholly false narrative.[v]

While the hour is late, it still makes sense for leaders in medicine, public health and nursing to speak up about what our civilization faces and what we can do about it. We doubt this will occur, for reasons everyone who has ever worked in an organization and to advance their careers understands.

It is possible that a rare leader will step forward –probably someone at the end of his or her career- and tell the populace that growth is over and sustainability is here. It will hurt and the powerful will attempt to cut their losses at the expense of the less powerful and powerless. But if people understand why this is happening –the ecological science explaining economic decline- utter social catastrophe can be avoided. Without this understanding political demagogues will come to the fore.

Dan Bednarz is co-editor of Health after Oil and President of Sustainable Health Systems.

J. Mac Crawford is Assistant Professor of Clinical Public Health in the Division of Environmental Health Sciences, the Ohio State University College of Public Health.

Nancy Lee Wood is Professor of Sociology and Director of the Institute for Sustainability and Post-carbon Education at Bristol Community College in Fall River, MA.

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2 comments

A very thoughtful and appropriate post. The situation, however, is bleaker than depicted.

The problem is that we are in overshoot. The “developing world” is catching up, but to provide them comparable living standards will take the resources of two and a half earths. Even to meet the projetced petroleum demands by mid-century will take three or four Saudi Arabias.

The pre-industrial world population was about a billion or so. Even if we allow that the less energy-intensive aspects of today’s technology will be retained – thus supporting a larger population in the post-industral world – absent today’s energy flows. the population supported will be but a fraction of what we have today.

Understanding is hampered by the lack of a clear perception of the various concepts lumped together under the term “economy”.

The secondary economy is the improvement to the primary economy througd the labor of humans (drafit animals, wind, solar and water power, and especially fossil fuels). This includes planting crops, managing timberlands. building levees, dams and breakwaters, and managing water resources. It also includes the consumables from such activity and from the primary economy, including food, clothing and shelter.

The teritary economy consists of manipulation of symbols repersenting values in the primary and secondary economies. These symbors can include cowrie shells, wampum, discs of gold, sirver and other metals (coins), pieces of paper with green pcitures of dead presidents, pixels on a computer screen, etc. Unlike the real objects is the primary and serordary economies, the symbols of the tertiary economy, when not linked to any real asset (i.e. “fiat currency”) can be increased in numbers with little hindrance. Since the primary and secondary economies do not increase pari passu, the increase is based on a promise of future growth in the primary and secondary economies.

When, however, resource restrictions limit such growth. the “fiat growth” of the tertiary economy collapses faster than do the primary and secondary economies.

Modern medicine is one of the most resource-intensive sectors of the economy. Throwing the inflating assets of the tertiary economy at it does not secure its long-term sustainability.